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��// LIQUID WASTE PERMIT ... <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.,3RD FLOOR,STOCKTON,CA 95202 (209)468-3420 <br /> ,Q }r_- <br /> NON-REFUNDABLE PERMIT EXPIRE I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2 12_ E. k5 <br /> CITY/LIPK� PARCEL S12FJAPN r F.S ",Q.8Z Z <br /> OWNER NAMETI CCIJE G�U`.0/ITE- YEM 5 a OkC 1T P07, 60K ZS0 CXp�T? <br /> CTTY2IP L,4181 f 63 30 PHONE (?!q {),C1JSd.(� ,.,I.�O.,,C,�)7 . <br /> CONTRACTOR W I IL tS. /�i,)4ncpscw r SLX I��; ADDRESS ZZ ;J' 'yL 11/I2N- T Il d �J . <br /> CITY/ZIP I 1po 1 /5 Z A Z PHONE���'�1 J(o 7 / /V <br /> GEOGRAPHICAL INFORMATION: COORDIIAN�X Y TOWNSHIP_RANGE SECTION <br /> PERC TEST(S) ( HOW MANY 1 APPLICATION B: <br /> TYPE OF SEPTIC WORK: ,YJ NEW INSTALLATION -❑_//REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ZR OMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPElMFG CAPACITY ' NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑LEACHING LINE NUMBER&LENGTH OF LINES / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION: PROPERTYLINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH ' <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINENI� <br /> 13 sumps WIDTH LENGTH DEPTH ({a <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I <br /> ❑DISPOSAL PONDS WIDTH LENGTH DEPTH (}�. <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE 1�' <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES, TATE LAWS D RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: l TITLE:i/ELD QER DATE: } y <br /> MARIPOSA ROAD <br /> Eb6BNG HOU6E <br /> TO REMNN <br /> Rte. C Ep6TING MFRX <br /> �gy5TEM9 TO REMAN <br /> D L <br /> re 6E &A4E E©. <br /> F <br /> 5CALE(APPROX.) <br /> Rs 1"=219 ��.. <br /> t� <br /> SAM J;,iA�UIN CCU"-' <br /> PUBI' HIAUHSFi,. , <br /> NCINITY MAP NAF:^,'Jh J IS: HF" TN. '�,-;• <br /> N� <br /> T a-69 WDUTAR �) M <br /> STORAGE LONTNNERS .d <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED L� DATE: l <br /> TANK,PH,OR SUMP MSPECTED dY: DATE: <br /> FINAL INSPECTION BY: <br /> COMMENTS: (n/ <br /> PE CODE FO REMI D AMOONT <br /> NTCHECK / RECEIVEDBY DATE MRMIT/SERVICE REQUEST x SEPTIC IDR <br />